Breast Augmentation Procedure Overview

There are many reasons, both medical and otherwise, for a patient to seek breast augmentation. Those who are living with frustrating conditions like asymmetry or tubular breasts as well as those who have gone through a mastectomy will consider augmentation for obvious corrective reasons, but the fundamental reason for most women is just to bring their body more in line with their own personal ideal. Appearances are very important both socially and in terms of self-image, and augmentation can be a great tool to achieve a sexier, more feminine appearance.

With modern techniques, the old stereotype about the “bolted-on” look no longer applies. Breast implants can look perfectly natural when done by a good surgeon who knows correct sizing and placement, and fortunately, here in New York City we have some of the finest cosmetic surgeons in the world, including Dr. Douglas Steinbrech.

Consultation

In the initial consultation, you’ll sit down with Dr. Steinbrech and discuss what you want to achieve with the augmentation and how best to do that. He will explain the sizes and types of implants and help you to choose what will work best for you as well as discussing where and how to place the implants.

In addition, you’ll discuss the steps you can take to minimize the risks of surgery, like getting a full medical screening from your regular doctor and stopping smoking for a few weeks to decrease the risk of complications like blood clotting and infection. Practical matters like recovery time will be included in the conversation, too.

Breast Implant Sizes

Despite the stereotype that women with breast implants are cartoonishly top-heavy, there are a wide range of size options available. You can certainly go for extremely busty, if that’s the look you’re after, but most women choose something a little more moderate.

The simplest way to select the correct size of implant for your needs is to place various sizes in your bra and look carefully at how you look in a well-fitted shirt. Dr. Steinbrech also suggests taking pictures of how various sizes look on your frame. Looking at a photo instead of a mirror offers a little psychological distance, which can make it easier to see things objectively. It also gives a good point of reference for your pre-surgery discussions.

Try to find a good middle ground in terms of size. Very large implants will look unnatural, assuming that’s something you’re worried about, and they can cause problems with finding clothes that fit. Larger implants also have a higher risk of complications. On the other hand, if you go with something too small, you might remain dissatisfied and end up back for another augmentation in a year or two, so choose carefully.

Breast Implant Options

There are two options for the contents of your implants: Silicone and saline. They differ in feel, price, and the ability to detect rupture.

Silicone implants have a bad rap because of safety problems with their earlier form, but they’ve been safely back on the market since 2006 and are becoming increasingly popular. They come pre-filled with silicone gel and are lighter and longer-lasting than saline implants. Silicone feels more natural and is less likely to ripple, so they are often recommended for extremely thin patients or patients with very little natural breast tissue to mask the implant. On the negative side, rupture is harder to detect with silicone, sometimes requiring an MRI.

Saline implants, on the other hand, are placed empty and then filled with a saline solution. Since they’re placed empty, they don’t need as big an incision as silicone, and they’re more adjustable, so size can be increased or decreased as needed during surgery. The edges of the implant are more detectable than a silicone implant, but when placed behind the muscle in a woman with sufficient breast tissue, they will feel extremely natural.

In addition to the different types of implants, there are also two main choices for placement: Above or below the muscle. While recovery is less painful if you place the implant above the muscle, Dr. Steinbrech prefers to go under the muscle because it feels more natural, is less likely to interfere with mammograms, and has a greatly reduced chance of rippling.

The final option is scar placement. The most common method is called inframammary and places the scar in the fold under the breast, leaving a small scar just an inch or two long. Since it’s under the breasts, it’s well-hidden even without clothes or in a bathing suit, and it offers good access for any necessary repositioning and shaping.

Peri-areolar placement, which goes under the nipple between the areola and the breast skin, is also common but becoming less popular. While the scar typically heals well, it’s in a conspicuous location, and since it requires cutting near the nipple and through a lot of breast tissue, there is a higher risk of affecting lactation and nipple sensitivity.

Underarm placement is a relatively new option that is increasingly popular. It leaves a very small scar in the underarm that can just look like a skin crease, and since it doesn’t require cutting through breast tissue or milk ducts, it has a very low chance of interfering with breastfeeding or mammograms. It can only be done with a saline implant, however, since it uses a very small incision, and any follow-up surgeries require a different approach because of the placement.

Finally, a belly-button approach gaining popularity because it supposedly reduces scarring, but it’s fairly risky because it involves cutting through both muscle and breast tissue. It also requires pushing implants through a tube that could damage them, and it does still leave a small scar about a centimeter long.

Possible Risks or Complications

Breast augmentation poses some of the same risks as any surgery: Bleeding and infection. These can be mitigated by cutting as minimally as possible, using a tumescent solution to reduce bleeding, and using antibiotics to prevent infection.

The most common of the augmentation-specific complications is capsular contracture, a hardening of the scar around the implant, which can cause pain or unnatural-looking implants. It’s generally caused by bleeding or infection, so precautions against those will guard against capsular contracture as well. There is also a chance of rippling, which can be visible or just noticeable to the touch.

This is best avoided by covering as much of the implant as possible with breast tissue or muscle. Finally, there is a chance of rupture because the lifespan of any implant is limited. Good follow-up care and quality implants can extend lifespan, but a ruptured implant will need to be removed and replaced.

FAQs

Do I need implants if I just want to correct sagging?

While combining augmentation with a lift is popular, it is generally not necessary. For women that desire more fullness, adding implants at the same time is a great option.

How long will the recovery be?

While most women go home a few hours after the surgery, you will need to use gauze dressings and a gentle support bra for a few days to keep everything comfortable and reduce swelling. Most women experience 1-2 days of intense recovery, followed by a few days of reduced activity and several weeks of soreness and swelling before everything feels normal again.

Will I be able to breastfeed?

Lactation is generally not affected since dissection isn’t done in the same place that milk is produced. While you should definitely discuss this with Dr. Steinbrech, generally the best bet is to go with an underarm or inframammary approach so as to disturb the nipple and milk ducts as little as possible.

Will I lose sensation in my nipples?

Chances in nipple sensation such as numbness or hypersensitivity are among many women’s top concerns about augmentations, but these changes occur almost exclusively with the peri-areolar approach. Discuss your concerns with Dr. Steinbrech, but as long as you choose a different approach, you should experience no change in sensitivity.

How do you correct asymmetrical breasts?

Asymmetry is faced by a surprising number of women, and it can be easily fixed during an augmentation. The normal procedure is to fill one implant more than the other to correct the asymmetry, but it’s also possible to augment one while simply lifting the other or even to perform an augmentation on one side and a reduction on the other. Learn more on Breast Reduction procedures.

Dr. Philip Miller, MD, FACS specializes exclusively in facial plastic surgery in New York and other cosmetic surgery, and has over 20 years' experience. He is recognized as an expert in rhinoplasty and facial rejuvenation procedures and is frequently invited to share his specific techniques with his peers at national facial plastic surgery meetings.